Systems, Apparatus and Methods for Sealing Perivalvular Leaks

ABSTRACT

An expandable member that is configured to engage an interior region of a prosthetic valve and capable of transitioning from a pre-deployment configuration at a pre-deployment temperature, where the expandable member is capable of being positioned in the valve at an interior valve region when the valve is disposed in a cardiovascular structure, to a post-deployment configuration when the expandable member is subjected to cardiovascular tissue temperature, where an outer surface region of the valve proximate the interior valve region is placed in intimate contact with host cardiovascular tissue of the cardiovascular structure at a first position and seals perivalvular leaks present at the first cardiovascular structure position.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims priority to U.S. Provisional Application No.61,876,540, filed on Sep. 11, 2013.

FIELD OF THE INVENTION

The present invention generally relates to replacement prostheticvalves. More particularly, the present invention relates to an apparatusand method for sealing perivalvular leaks; particularly, during or aftera cardiovascular valve replacement.

BACKGROUND OF THE INVENTION

As is well known in the art, the human heart has four valves thatcontrol blood flow circulating through the human body. On the left sideof the heart is the mitral valve, located between the left atrium andthe left ventricle, and the aortic valve, located between the leftventricle and the aorta. Both of these valves direct oxygenated bloodfrom the lungs into the aorta for distribution through the body.

The tricuspid valve, located between the right atrium and the rightventricle, and the pulmonary valve, located between the right ventricleand the pulmonary artery, however, are situated on the right side of theheart and direct deoxygenated blood from the body to the lungs.

The peripheral venous system also includes a number of valves thatprevent retrograde blood flow. By preventing retrograde blood flow, thevalves found throughout the venous system assist the flow of bloodthrough the veins and returning to the heart.

Normally, the mitral valve has two leaflets and the tricuspid valve hasat least two, preferably, three leaflets. The aortic and pulmonaryvalves, however, have normally at least two, preferably three leaflets,also often referred to as “cusps” because of their half-moon likeappearance.

Venous valves are usually of the bicuspid type, with each cusp orleaflet forming a reservoir for blood, which, under pressure, forces thefree edges of the cusps together to permit mostly antegrade blood flowto the heart. As discussed in detail below, since a majority of venousblood flow is against gravity while a person is standing, incompetent ordestroyed venous valves can cause significant medical problems in thelegs, ankles, and feet.

Valve diseases are typically classified into two major categories;stenosis and insufficiency. In the case of a stenosis, the native valvedoes not open properly, whereby insufficiency represents the oppositeeffect showing deficient closing properties.

Insufficiency of the inlet (atrioventricular) tricuspid valve to theright ventricle of the heart results in regurgitation of blood back intothe right atrium, which, serving to receive blood flow returning in theveins from the entire body, then results, in turn, in suffusion andswelling (edema) of all the organs, most notably in the abdomen andextremities, insufficient forward conduction of blood flow from theright ventricle into the lungs causing compromise of pulmonary function,and ultimately pump failure of the right heart. Collectively theseconditions are termed right heart failure, a condition that leads toincapacity and possibly to death if progressive and uncorrected.

Insufficiency of vein function due to the incompetence or destruction ofperipheral venous valves leads to acute then chronic swelling of theveins and their dependent lymphatics and tissues. This condition canaffect the deep veins of the body, commonly the lower extremities orpelvis, or the superficial veins of the lower extremities in particular,leading to progressive expansion of the veins and further valvularincompetence, a condition known as varicose veins.

Medical conditions like high blood pressure, inflammatory and infectiousprocesses often lead to stenosis and insufficiency. Treatment of heartvalve dysfunctions typically include reparation of the diseased heartvalve with preservation of the patient's own valve or replacement of thevalve with a mechanical or bioprosthetic valve (i.e. “tissue” valve),i.e. a prosthetic valve. Particularly for aortic heart valves, however,it is frequently necessary to introduce a heart valve replacement.

Various prosthetic heart valves have thus been developed for replacementof natural diseased or defective valves. Illustrative are thebioprosthetic “tissue” valves disclosed in Applicant's Co-Pendingapplication Ser. No. 13/560,573.

The implantation of a prosthetic valve, including mechanical valves andbioprosthetic valves, requires a great deal of skill and concentrationgiven the delicate nature of the native cardiovascular tissue and thespatial constraints of the surgical field. It is also critical toachieve a secure and reliable attachment of the valve to hostcardiovascular tissue.

Various structures and means have thus been developed to provide asecure and reliable attachment of a prosthetic valve to hostcardiovascular tissue. Most surgical techniques comprise suturing theends of the valve to the annulus of the cardiovascular vessel.

There are numerous drawbacks and disadvantages associated with suturinga valve to host tissue. A major disadvantage is the high risk of aperivalvular leak.

In application Ser. No. 13/560,573 the tissue valve includes a sewingring that can be employed to suture the ends of the valve to the annulusof the cardiovascular vessel. Although the use of a sewing ring tosecure the valve to a cardiovascular vessel can be, and most times is,highly effective, success of the technique is still highly dependent onthe skill of the surgeon.

Perivalvular leaks are also often encountered during or after acardiovascular valve replacement due to placement of the replacementvalve over native valve leaflets, which are often calcified. Asillustrated in FIG. 1, the calcified leaflets 12 are, thus, wedgedbetween the replacement valve 14 a and the vessel 16, which results ingaps 18 between the valve 14 a and vessel 16 that lead to perivalvularleaks.

There is thus a need to provide an apparatus and method for sealingperivalvular leaks; particularly, leaks encountered during or after acardiovascular valve replacement.

It is therefore an object of the present invention to provide anapparatus and method for sealing perivalvular leaks; particularly, leaksencountered during or after a cardiovascular valve replacement.

It is another object of the present invention to provide an apparatusfor sealing perivalvular leaks that induces regeneration ofcardiovascular tissue.

SUMMARY OF THE INVENTION

The present invention is directed to systems, apparatus and methods forsealing perivalvular leaks; particularly, leaks encountered during orafter a cardiovascular valve replacement.

In a preferred embodiment, the perivalvular leak sealing apparatuscomprises a biocompatible, expandable member that is configured toengage an interior region of a prosthetic valve.

In some embodiments of the invention, the perivalvular leak sealingapparatus comprises a biocompatible shape memory alloy member that iscapable of transitioning from a pre-deployment configuration at a firsttemperature, wherein the expandable member is capable of beingpositioned proximate the internal valve region when the valve isdisposed in a cardiovascular structure, the cardiovascular structurecomprising host cardiovascular tissue having a first tissue temperature,to a post-deployment configuration when the expandable member isdisposed proximate the cardiovascular tissue and subjected to the firsttissue temperature, wherein, when the expandable member is disposed inthe internal valve region, the valve outer surface proximate theinterior valve region is placed in intimate contact with the hostcardiovascular tissue of the cardiovascular structure at acardiovascular structure target region and seals perivalvular leakspresent at the structure target region.

In some embodiments of the invention, the perivalvular leak sealingapparatus comprises a bioremodelable member that is capable oftransitioning from a pre-deployment configuration, wherein theexpandable member is similarly capable of being positioned at theinternal valve region of the valve when the valve is disposed in acardiovascular structure, to a post-deployment configuration, wherein,when the expandable member is disposed at the internal valve region, thevalve outer surface proximate the interior valve region is placed inintimate contact with host cardiovascular tissue of the cardiovascularstructure at a cardiovascular structure target region and sealsperivalvular leaks present at the structure target region.

In some embodiments of the invention, the bioremodeable materialcomprises an extracellular matrix (ECM) material. According to theinvention, the ECM material can be derived from various mammalian tissuesources including, without limitation, small intestine submucosa (SIS),urinary bladder submucosa (UBS), stomach submucosa (SS), central nervoussystem tissue, epithelium of mesodermal origin, i.e. mesothelial tissue,dermal extracellular matrix, subcutaneous extracellular matrix,gastrointestinal extracellular matrix, i.e. large and small intestines,tissue surrounding growing bone, placental extracellular matrix,ornamentum extracellular matrix, cardiac extracellular matrix, e.g.,pericardium and/or myocardium, kidney extracellular matrix, pancreasextracellular matrix, lung extracellular matrix, and combinationsthereof. The ECM material can also comprise collagen from mammaliansources.

In some embodiments of the invention, the ECM material (and/or ECMexpandable member formed therefrom) comprises at least one supplementalbiologically active agent (or composition).

In some embodiments of the invention, the biologically active agentcomprises a hemostatic agent or composition.

In some embodiments, the hemostatic agent comprises thrombin.

In some embodiments, the hemostatic agent comprises fibrinogen.

In some embodiments, the hemostatic agent is selected from the groupcomprising fibronectin, plasminogen, aprotinin, α-2-antiplasmin, α-2macroglobulin, α-1-antitrypsin, epsilon-aminocaproic acid, tranexamicacid, and a plasmin activator inhibitor, e.g., PAI-1 and PAI-2.

In some embodiments of the invention, the biologically active agentcomprises a statin, i.e. a HMG-CoA reductase inhibitor, selected fromthe group comprising atorvastatin, cerivastatin, fluvastatin,lovastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, andsimvastatin.

In some embodiments of the invention, the biologically active agentcomprises a cell selected from the group comprising human embryonic stemcells, fetal cardiomyocytes, myofibroblasts, mesenchymal stem cells,autotransplated expanded cardiomyocytes, adipocytes, totipotent cells,pluripotent cells, blood stem cells, myoblasts, adult stem cells, bonemarrow cells, mesenchymal cells, embryonic stem cells, parenchymalcells, epithelial cells, endothelial cells, mesothelial cells,fibroblasts, osteoblasts, chondrocytes, exogenous cells, endogenouscells, stem cells, hematopoietic stem cells, bone-marrow derivedprogenitor cells, myocardial cells, skeletal cells, fetal cells,undifferentiated cells, multi-potent progenitor cells, unipotentprogenitor cells, monocytes, cardiac myoblasts, skeletal myoblasts,macrophages, capillary endothelial cells, xenogenic cells, allogeniccells, and post-natal stem cells.

In some embodiments of the invention, the biologically active agentcomprises a growth factor selected from the group comprising a plateletderived growth factor (PDGF), epidermal growth factor (EGF),transforming growth factor-α (TGF-α), transforming growth factor beta(TGF-β), fibroblast growth factor-2 (FGF-2), basic fibroblast growthfactor (bFGF), vascular epithelial growth factor (VEGF), hepatocytegrowth factor (HGF), insulin-like growth factor (IGF), nerve growthfactor (NGF), platelet derived growth factor (PDGF), tumor necrosisfactor α (TNA-α), and placental growth factor (PLGF).

In some embodiments, the biologically active agent comprises apharmacological agent (or composition), i.e. an agent or compositionthat is capable of producing a desired biological effect in vivo, e.g.,stimulation or suppression of apoptosis, stimulation or suppression ofan immune response, etc.

According to the invention, the pharmacological agent or composition cancomprise, without limitation, antibiotics or antifungal agents,anti-viral agents, anti-pain agents, anesthetics, analgesics, steroidalanti-inflammatories, non-steroidal anti-inflammatories,anti-neoplastics, anti-spasmodics, modulators of cell-extracellularmatrix interactions, proteins, hormones, enzymes and enzyme inhibitors,anticoagulants and/or antithrombic agents, DNA, RNA, modified DNA andRNA, NSAIDs, inhibitors of DNA, RNA or protein synthesis, polypeptides,oligonucleotides, polynucleotides, nucleoproteins, compounds modulatingcell migration, compounds modulating proliferation and growth of tissue,and vasodilating agents.

In a preferred embodiment of the invention, the expandable ECM membercomprises a flexible, porous, e.g., sponge-like, structure.

In some embodiments of the invention, the expandable member includes orcomprises a support (or anchoring) member that is similarly capable oftransitioning from a pre-deployment configuration, the support memberand/or expandable member similarly being capable of being positioned atthe internal valve region of the valve when the valve is disposed in acardiovascular structure, to a post-deployment configuration, wherein,when the support member and/or expandable member is disposed at theinternal valve region, the outer surface of the valve proximate thevalve region is placed in intimate contact with host cardiovasculartissue of the cardiovascular structure at a cardiovascular structuretarget region and seals perivalvular leaks present at the structuretarget region.

In some embodiments of the invention, the support member comprises areinforcing ring or band that is positioned in or on the expandablemember.

In some embodiments, the support member comprises a microneedle supportmember having a plurality of biodegradable microneedles or barbs thatare configured and positioned to maintain the position of the expandablemember and, hence, a valve outer surface proximate host cardiovasculartissue.

In some embodiments, the support member comprises a biodegradablematerial, including, without limitation, magnesium and an ECM material.

In some embodiments, the support member comprises a biocompatiblepolymeric material, including, without limitation, Artelon™.

BRIEF DESCRIPTION OF THE DRAWINGS

Further features and advantages will become apparent from the followingand more particular description of the preferred embodiments of theinvention, as illustrated in the accompanying drawings, and in whichlike referenced characters generally refer to the same parts or elementsthroughout the views, and in which:

FIG. 1 is a schematic illustration of a replacement valve disposed in acardiovascular vessel, showing gaps and, hence, perivalvular leakregions therebetween;

FIG. 2 is a side plan view of one embodiment of a perivalvular leaksealing apparatus in a pre-deployment configuration, in accordance withthe invention;

FIG. 3 is a side plan view of the perivalvular leak sealing apparatusshown in FIG. 2 in a post-deployment configuration, in accordance withthe invention;

FIG. 4 is a side plan view of the perivalvular leak sealing apparatusshown in FIG. 3 positioned at an internal valve region of a valvedisposed in a cardiovascular vessel, in accordance with the invention;

FIG. 5 is a side plan view of the perivalvular leak sealing apparatusshown in FIG. 3 positioned at an internal valve region of a valvedisposed in a cardiovascular structure, in accordance with theinvention;

FIG. 6 is a partial side plan sectional view of one embodiment of aperivalvular leak sealing apparatus having a support member disposedwithin the expandable member, in accordance with the invention;

FIG. 7 is a partial side plan sectional view of another embodiment of aperivalvular leak sealing apparatus having a support member disposedproximate the outer surface of the expandable member, in accordance withthe invention;

FIG. 8 is a partial side plan sectional view of another embodiment of aperivalvular leak sealing apparatus having a microneedle support membermember, in accordance with the invention.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENT

Before describing the present invention in detail, it is to beunderstood that this invention is not limited to particularlyexemplified apparatus, systems, structures or methods as such may, ofcourse, vary. Thus, although a number of apparatus, systems and methodssimilar or equivalent to those described herein can be used in thepractice of the present invention, the preferred apparatus, systems,structures and methods are described herein.

It is also to be understood that the terminology used herein is for thepurpose of describing particular embodiments of the invention only andis not intended to be limiting.

Unless defined otherwise, all technical and scientific terms used hereinhave the same meaning as commonly understood by one having ordinaryskill in the art to which the invention pertains.

Further, all publications, patents and patent applications cited herein,whether supra or infra, are hereby incorporated by reference in theirentirety.

As used in this specification and the appended claims, the singularforms “a, “an” and “the” include plural referents unless the contentclearly dictates otherwise. Thus, for example, reference to “apharmacological agent” includes two or more such agents and the like.

Further, ranges can be expressed herein as from “about” or“approximately” one particular value, and/or to “about” or“approximately” another particular value. When such a range isexpressed, another embodiment includes from the one particular valueand/or to the other particular value. Similarly, when values areexpressed as approximations, by use of the antecedent “about” or“approximately”, it will be understood that the particular value formsanother embodiment. It will be further understood that the endpoints ofeach of the ranges are significant both in relation to the otherendpoint, and independently of the other endpoint.

It is also understood that there are a number of values disclosedherein, and that each value is also herein disclosed as “about” or“approximately” that particular value in addition to the value itself.For example, if the value “10” is disclosed, then “approximately 10” isalso disclosed. It is also understood that when a value is disclosedthat “less than or equal to” the value, “greater than or equal to thevalue” and possible ranges between values are also disclosed, asappropriately understood by the skilled artisan. For example, if thevalue “10” is disclosed then “less than or equal to 10” as well as“greater than or equal to 10” is also disclosed.

DEFINITIONS

The terms “extracellular matrix”, “ECM” and “ECM material” are usedinterchangeably herein, and mean and include a collagen-rich substancethat is found in between cells in mammalian tissue, and any materialprocessed therefrom, e.g. decellularized ECM. According to theinvention, the ECM material can be derived from a variety of mammaliantissue sources, including, without limitation, small intestine submucosa(SIS), urinary bladder submucosa (UBS), stomach submucosa (SS), centralnervous system tissue, dermal extracellular matrix, subcutaneousextracellular matrix, gastrointestinal extracellular matrix, i.e. largeand small intestines, tissue surrounding growing bone, placentalextracellular matrix, ornamentum extracellular matrix, cardiacextracellular matrix, e.g., pericardium and/or myocardium, kidneyextracellular matrix, pancreas extracellular matrix, lung extracellularmatrix, and combinations thereof. The ECM material can also comprisecollagen from mammalian sources.

The terms “urinary bladder submucosa (UBS)”, “small intestine submucosa(SIS)” and “stomach submucosa (SS)” also mean and include any UBS and/orSIS and/or SS material that includes the tunica mucosa (which includesthe transitional epithelial layer and the tunica propria), submucosallayer, one or more layers of muscularis, and adventitia (a looseconnective tissue layer) associated therewith.

The ECM material can also be derived from epithelium of mesodermalorigin, i.e. mesothelial tissue.

The ECM material can additionally be derived from basement membrane ofmammalian tissue/organs, including, without limitation, urinary basementmembrane (UBM), liver basement membrane (LBM), and amnion, chorion,allograft pericardium, allograft acellular dermis, amniotic membrane,Wharton's jelly, and combinations thereof.

Additional sources of mammalian basement membrane include, withoutlimitation, spleen, lymph nodes, salivary glands, prostate, pancreas andother secreting glands.

The ECM material can also be derived from other sources, including,without limitation, collagen from plant sources and synthesizedextracellular matrices, i.e. cell cultures.

The terms “sponge” and “sponge-like configuration” are usedinterchangeably herein, and mean and include an elastic, porousstructure that is capable of absorbing a bodily fluid when in contacttherewith and expanding, i.e. increasing in mass, thereafter.

The terms “biologically active agent” and “biologically activecomposition” are used interchangeably herein, and mean and include agentthat induces or modulates a physiological or biological process, orcellular activity, e.g., induces proliferation, and/or growth and/orregeneration of tissue.

The terms “biologically active agent” and “biologically activecomposition”, as used herein, thus mean and include a hemostatic agentor composition, including, without limitation, thrombin, fibrinogen,fibronectin, plasminogen, aprotinin, α-2-antiplasmin, α-2 macroglobulin,α-1-antitrypsin, epsilon-aminocaproic acid, tranexamic acid, and aplasmin activator inhibitor, e.g., PAI-1 and PAI-2.

The terms “biologically active agent” and “biologically activecomposition” also mean and include, without limitation, the followinggrowth factors: platelet derived growth factor (PDGF), epidermal growthfactor (EGF), transforming growth factor α (TGF-α), transforming growthfactor beta (TGF-β), fibroblast growth factor-2 (FGF-2), basicfibroblast growth factor (bFGF), vascular epithelial growth factor(VEGF), hepatocyte growth factor (HGF), insulin-like growth factor(IGF), nerve growth factor (NGF), platelet derived growth factor (PDGF),tumor necrosis factor-α (TNA-α), and placental growth factor (PLGF).

The terms “biologically active agent” and “biologically activecomposition” also mean and include, without limitation, human embryonicstem cells, fetal cardiomyocytes, myofibroblasts, mesenchymal stemcells, autotransplated expanded cardiomyocytes, adipocytes, totipotentcells, pluripotent cells, blood stem cells, myoblasts, adult stem cells,bone marrow cells, mesenchymal cells, embryonic stem cells, parenchymalcells, epithelial cells, endothelial cells, mesothelial cells,fibroblasts, osteoblasts, chondrocytes, exogenous cells, endogenouscells, stem cells, hematopoietic stem cells, bone-marrow derivedprogenitor cells, myocardial cells, skeletal cells, fetal cells,undifferentiated cells, multi-potent progenitor cells, unipotentprogenitor cells, monocytes, cardiac myoblasts, skeletal myoblasts,macrophages, capillary endothelial cells, xenogenic cells, allogeniccells, and post-natal stem cells.

The terms “biologically active agent” and “biologically activecomposition” also mean and include, without limitation, the followingbiologically active agents (referred to interchangeably herein as a“protein”, “peptide” and “polypeptide”): collagen (types 1-V),proteoglycans, glycosaminoglycans (GAGs), glycoproteins, growth factors,cytokines, cell-surface associated proteins, cell adhesion molecules(CAM), angiogenic growth factors, endothelial ligands, matrikines,cadherins, immuoglobins, fibril collagens, non-fibrallar collagens,basement membrane collagens, multiplexins, small-leucine richproteoglycans, decorins, biglycans, fibromodulins, keratocans, lumicans,epiphycans, heparin sulfate proteoglycans, perlecans, agrins, testicans,syndecans, glypicans, serglycins, selectins, lecticans, aggrecans,versicans, neurocans, brevicans, cytoplasmic domain-44 (CD-44),macrophage stimulating factors, amyloid precursor proteins, heparins,chondroitin sulfate B (dermatan sulfate), chondroitin sulfate A, heparinsulfates, hyaluronic acids, fibronectins, tenascins, elastins,fibrillins, laminins, nidogen/enactins, fibulin I, finulin II,integrins, transmembrane molecules, thrombospondins, ostepontins, andangiotensin converting enzymes (ACE).

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” are used interchangeably herein, and mean and includean agent, drug, compound, composition of matter or mixture thereof,including its formulation, which provides some therapeutic, oftenbeneficial, effect. This includes any physiologically orpharmacologically active substance that produces a localized or systemiceffect or effects in animals, including warm blooded mammals, humans andprimates; avians; domestic household or faint animals, such as cats,dogs, sheep, goats, cattle, horses and pigs; laboratory animals, such asmice, rats and guinea pigs; fish; reptiles; zoo and wild animals; andthe like.

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” thus mean and include, without limitation,antibiotics, anti-arrhythmic agents, anti-viral agents, analgesics,steroidal anti-inflammatories, non-steroidal anti-inflammatories,anti-neoplastics, anti-spasmodics, modulators of cell-extracellularmatrix interactions, proteins, hormones, growth factors, matrixmetalloproteinases (MMPS), enzymes and enzyme inhibitors, anticoagulantsand/or antithrombic agents, DNA, RNA, modified DNA and RNA, NSAIDs,inhibitors of DNA, RNA or protein synthesis, polypeptides,oligonucleotides, polynucleotides, nucleoproteins, compounds modulatingcell migration, compounds modulating proliferation and growth of tissue,and vasodilating agents.

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” thus include, without limitation, atropine,tropicamide, dexamethasone, dexamethasone phosphate, betamethasone,betamethasone phosphate, prednisolone, triamcinolone, triamcinoloneacetonide, fluocinolone acetonide, anecortave acetate, budesonide,cyclosporine, FK-506, rapamycin, ruboxistaurin, midostaurin,flurbiprofen, suprofen, ketoprofen, diclofenac, ketorolac, nepafenac,lidocaine, neomycin, polymyxin b, bacitracin, gramicidin, gentamicin,oyxtetracycline, ciprofloxacin, ofloxacin, tobramycin, amikacin,vancomycin, cefazolin, ticarcillin, chloramphenicol, miconazole,itraconazole, trifluridine, vidarabine, ganciclovir, acyclovir,cidofovir, ara-amp, foscarnet, idoxuridine, adefovir dipivoxil,methotrexate, carboplatin, phenylephrine, epinephrine, dipivefrin,timolol, 6-hydroxydopamine, betaxolol, pilocarpine, carbachol,physostigmine, demecarium, dorzolamide, brinzolamide, latanoprost,sodium hyaluronate, insulin, verteporfin, pegaptanib, ranibizumab, andother antibodies, antineoplastics, anti-VEGFs, ciliary neurotrophicfactor, brain-derived neurotrophic factor, bFGF, Caspase-1 inhibitors,Caspase-3 inhibitors, α-Adrenoceptors agonists, NMDA antagonists, Glialcell line-derived neurotrophic factors (GDNF), pigmentepithelium-derived factor (PEDF), and NT-3, NT-4, NGF, IGF-2.

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” further mean and include the following Class I-ClassV antiarrhythmic agents: (Class Ia) quinidine, procainamide anddisopyramide; (Class Ib) lidocaine, phenyloin and mexiletine; (Class Ic)flecamide, propafenone and moricizine; (Class II) propranolol, esmolol,timolol, metoprolol and atenolol; (Class III) amiodarone, sotalol,ibutilide and dofetilide; (Class IV) verapamil and diltiazem) and (ClassV) adenosine and digoxin.

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” further mean and include, without limitation, thefollowing antibiotics: aminoglycosides, cephalosporins, chloramphenicol,clindamycin, erythromycins, fluoroquinolones, macrolides, azolides,metronidazole, penicillins, tetracyclines, trimethoprim-sulfamethoxazoleand vancomycin.

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” further include, without limitation, the followingsteroids: andranes (e.g., testosterone), cholestanes, cholic acids,corticosteroids (e.g., dexamethasone), estraenes (e.g., estradiol) andpregnanes (e.g., progesterone).

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” can further include one or more classes of narcoticanalgesics, including, without limitation, morphine, codeine, heroin,hydromorphone, levorphanol, meperidine, methadone, oxycodone,propoxyphene, fentanyl, methadone, naloxone, buprenorphine, butorphanol,nalbuphine and pentazocine.

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” can further include one or more classes of topical orlocal anesthetics, including, without limitation, esters, such asbenzocaine, chloroprocaine, cocaine, cyclomethycaine,dimethocaine/larocaine, piperocaine, propoxycaine, procaine/novacaine,proparacaine, and tetracaine/amethocaine. Local anesthetics can alsoinclude, without limitation, amides, such as articaine, bupivacaine,cinchocaine/dibucaine, etidocaine, levobupivacaine,lidocaine/lignocaine, mepivacaine, prilocaine, ropivacaine, andtrimecaine. Local anesthetics can further include combinations of theabove from either amides or esters.

The terms “pharmacological agent”, “active agent”, “drug” and “activeagent formulation” can further include one or more classes of cytotoxicanti-neoplastic agents or chemotherapy agents, including, withoutlimitation, alkylating agents, cisplatin, carboplatin, oxaliplatin,mechlorethamine, cyclophosphamide, chlorambucil, and ifosfamide.Chemotherapy agents can also include, without limitation,antimetabolites, such as purine analogues, pyrimidine analogues andantifolates, plant alkaloids, such as vincristine, vinblastine,vinorelbine, vindesine, podophyllotoxin, etoposide and teniposide,taxanes, such as paclitaxel and docetaxel, topoisomerase inhibitors,such as irinotecan, topotecan, amsacrine, etoposide, etoposide phosphateand teniposide, cytotoxic antibiotics, such as actinomyocin, bleomycin,plicamycin, mytomycin and anthracyclines, such as doxorubicin,daunorubicin, valrubicin, idarubicin, epirubicin, and antibodytreatments, such as abciximab, adamlimumab, alamtuzumab, basiliximab,belimumab, bevacizumab, brentuximab vedotin, canakinumab, cetuximab,certolizumab pego, daclizumab, denosumab, eculizumab, efalizumab,gemtuzumab, golimumab, ibritumomab tiuxetan, infliximab, ipilimumab,muromonab-CD3, natalizumab, ofatumumab, omalizumab, palivizumab,panitumumab, ranibizumab, rituximab, tocilizumab (atlizumab),tositumomab and trastuzumab.

The terms “anti-inflammatory” and “anti-inflammatory agent” are alsoused interchangeably herein, and mean and include a “pharmacologicalagent” and/or “active agent formulation”, which, when a therapeuticallyeffective amount is administered to a subject, prevents or treats bodilytissue inflammation i.e. the protective tissue response to injury ordestruction of tissues, which serves to destroy, dilute, or wall offboth the injurious agent and the injured tissues.

Anti-inflammatory agents thus include, without limitation, alclofenac,alclometasone dipropionate, algestone acetonide, a amylase, amcinafal,amcinafide, amfenac sodium, amiprilose hydrochloride, anakinra,anirolac, anitrazafen, apazone, balsalazide disodium, bendazac,benoxaprofen, benzydamine hydrochloride, bromelains, broperamole,budesonide, carprofen, cicloprofen, cintazone, cliprofen, clobetasolpropionate, clobetasone butyrate, clopirac, cloticasone propionate,cormethasone acetate, cortodoxone, decanoate, deflazacort, delatestryl,depo-testosterone, desonide, desoximetasone, dexamethasone dipropionate,diclofenac potassium, diclofenac sodium, diflorasone diacetate,diflumidone sodium, diflunisal, difluprednate, diftalone, dimethylsulfoxide, drocinonide, endrysone, enlimomab, enolicam sodium,epirizole, etodolac, etofenamate, felbinac, fenamole, fenbufen,fenclofenac, fenclorac, fendosal, fenpipalone, fentiazac, flazalone,fluazacort, flufenamic acid, flumizole, flunisolide acetate, flunixin,flunixin meglumine, fluocortin butyl, fluorometholone acetate,fluquazone, flurbiprofen, fluretofen, fluticasone propionate,furaprofen, furobufen, halcinonide, halobetasol propionate, halopredoneacetate, ibufenac, ibuprofen, ibuprofen aluminum, ibuprofen piconol,ilonidap, indomethacin, indomethacin sodium, indoprofen, indoxole,intrazole, isoflupredone acetate, isoxepac, isoxicam, ketoprofen,lofemizole hydrochloride, lomoxicam, loteprednol etabonate,meclofenamate sodium, meclofenamic acid, meclorisone dibutyrate,mefenamic acid, mesalamine, meseclazone, mesterolone,methandrostenolone, methenolone, methenolone acetate, methylprednisolonesuleptanate, morniflumate, nabumetone, nandrolone, naproxen, naproxensodium, naproxol, nirnazone, olsalazine sodium, orgotein, orpanoxin,oxandrolane, oxaprozin, oxyphenbutazone, oxymetholone, paranylinehydrochloride, pentosan polysulfate sodium, phenbutazone sodiumglycerate, pirfenidone, piroxicam, piroxicam cinnamate, piroxicamolamine, pirprofen, prednazate, prifelone, prodolic acid, proquazone,proxazole, proxazole citrate, rimexolone, romazarit, salcolex,salnacedin, salsalate, sanguinarium chloride, seclazone, sermetacin,stanozolol, sudoxicam, sulindac, suprofen, talmetacin, talniflumate,talosalate, tebufelone, tenidap, tenidap sodium, tenoxicam, tesicam,tesimide, testosterone, testosterone blends, tetrydamine, tiopinac,tixocortol pivalate, tolmetin, tolmetin sodium, triclonide,triflumidate, zidometacin, and zomepirac sodium.

The term “therapeutically effective”, as used herein, means that theamount of the “pharmacological agent” and/or “biologically active agent”and/or “pharmacological composition” administered is of sufficientquantity to ameliorate one or more causes, symptoms, or sequelae of adisease or disorder. Such amelioration only requires a reduction oralteration, not necessarily elimination, of the cause, symptom, orsequelae of a disease or disorder.

The terms “abate”, “prevent” and “preventing” are used interchangeablyherein, and mean and include reducing the frequency or severity of acondition or disorder. The term does not require an absolute preclusionof the condition or disorder.

The terms “treat” and “treatment” are used interchangeably herein, andmean and include medical management of a patient with the intent tocure, ameliorate, stabilize, or prevent a disease, pathologicalcondition or disorder. The terms include “active treatment”, i.e.treatment directed specifically toward the improvement of a disease,pathological condition or disorder, and “causal treatment”, i.e.treatment directed toward removal of the cause of the associateddisease, pathological condition or disorder.

The terms “treat” and “treatment” further include “palliativetreatment”, i.e. treatment designed for the relief of symptoms ratherthan the curing of the disease, pathological condition or disorder,“preventative treatment”, i.e. treatment directed to minimizing orpartially or completely inhibiting the development of the associateddisease, pathological condition or disorder, and “supportive treatment”,i.e. treatment employed to supplement another specific therapy directedtoward the improvement of the associated disease, pathological conditionor disorder.

The terms “prosthetic valve” and “valve” are used interchangeablyherein, and mean and include a valve construct that is configured toreplace a native cardiovascular valve, such as the valve constructsdisclosed in U.S. Pat. Nos. 8,696,744 and 7,998,196, and Co-pending U.S.application Ser. Nos. 13/782,024, 13/782,289, 13/804,683 and 13/480,347.

The terms “delivery” and “administration” are used interchangeablyherein, and mean and include placing a perivalvular leak sealingapparatus or system of the invention in an internal region of acardiovascular valve through any method appropriate to deliver theperivalvular leak sealing apparatus.

The term “supplemental” and variations of the term, such as “augmented”,as used in connection with a “biologically active agent or composition”,means and includes the introduction of an additional non-native agent tothe bioremodeable or ECM material (and/or an expandable ECM memberformed therefrom), and introducing additional native agents to thebioremodelable or ECM material (and/or an expandable ECM member formedtherefrom), e.g., fibroblast growth factor-2 (FGF-2) to increase thepopulation of a native agent.

The term “comprise” and variations of the term, such as “comprising” and“comprises,” means “including, but not limited to” and is not intendedto exclude, for example, other additives, components, integers or steps.

The terms “patient” and “subject” are used interchangeably herein, andmean and include warm blooded mammals, humans and primates; avians;domestic household or farm animals, such as cats, dogs, sheep, goats,cattle, horses and pigs; laboratory animals, such as mice, rats andguinea pigs; fish; reptiles; zoo and wild animals; and the like.

The following disclosure is provided to further explain in an enablingfashion the best modes of performing one or more embodiments of thepresent invention. The disclosure is further offered to enhance anunderstanding and appreciation for the inventive principles andadvantages thereof, rather than to limit in any manner the invention.The invention is defined solely by the appended claims including anyamendments made during the pendency of this application and allequivalents of those claims as issued.

As stated above, the present invention is directed to systems, apparatusand methods for sealing perivalvular leaks; particularly, leaksencountered during or after a cardiovascular valve replacement.

In a preferred embodiment, the perivalvular leak sealing apparatuscomprises a biocompatible, expandable member that is configured toengage an interior region of a prosthetic valve.

In some embodiments of the invention, the perivalvular leak sealingapparatus comprises a biocompatible shape memory alloy member that iscapable of transitioning from a pre-deployment configuration at a firsttemperature, wherein the expandable member is capable of beingpositioned proximate the internal valve region when the valve isdisposed in a cardiovascular structure, the cardiovascular structurecomprising host cardiovascular tissue having a first tissue temperature,to a post-deployment configuration when the expandable member isdisposed proximate the cardiovascular tissue and subjected to the firsttissue temperature, wherein, when the expandable member is disposed inthe interior valve region, the valve outer surface proximate theinterior valve region is placed in intimate contact with the hostcardiovascular tissue of the cardiovascular structure at acardiovascular structure target region and seals perivalvular leakspresent at the structure target region.

In some embodiments of the invention, the perivalvular leak sealingapparatus comprises a bioremodelable member that is similarly capable oftransitioning from a pre-deployment configuration, wherein theexpandable member is capable of being positioned at the interior valveregion when the valve is disposed in a cardiovascular structure, to apost-deployment configuration, wherein, when the expandable member isdisposed at the internal valve region, the valve outer surface proximatethe interior valve region is placed in intimate contact with hostcardiovascular tissue of the cardiovascular structure at acardiovascular structure target region and seals perivalvular leakspresent at the structure target region.

In some embodiments of the invention, the bioremodelable material (and,hence, expandable member formed therefrom) comprises an extracellularmatrix (ECM) material (hereinafter “expandable ECM member”). Accordingto the invention, the ECM material can be derived from various mammaliantissue sources and methods for preparing same, such as disclosed in U.S.Pat. Nos. 7,550,004, 7,244,444, 6,379,710, 6,358,284, 6,206,931,5,733,337 and 4,902,508 and U.S. application Ser. No. 12/707,427; whichare incorporated by reference herein in their entirety. Suitablemammalian tissue sources include, without limitation, small intestinesubmucosa (SIS), urinary bladder submucosa (UBS), stomach submucosa(SS), central nervous system tissue, dermal extracellular matrix,subcutaneous extracellular matrix, gastrointestinal extracellularmatrix, i.e. large and small intestines, tissue surrounding growingbone, placental extracellular matrix, ornamentum extracellular matrix,cardiac extracellular matrix, e.g., pericardium and/or myocardium,kidney extracellular matrix, pancreas extracellular matrix, lungextracellular matrix, and combinations thereof. The ECM material canalso comprise collagen from mammalian sources.

The terms “urinary bladder submucosa (UBS),” “small intestine submucosa(SIS)” and “stomach submucosa (SS)” also mean and include any UBS and/orSIS and/or SS material that includes the tunica mucosa (which includesthe transitional epithelial layer and the tunica propria), submucosallayer, one or more layers of muscularis, and adventitia (a looseconnective tissue layer) associated therewith.

The ECM material can also be derived from epithelium of mesodermalorigin, i.e. mesothelial tissue, as well as the basement membrane ofmammalian tissue/organs, including, without limitation, urinary basementmembrane (UBM), liver basement membrane (LBM), and amnion, chorion,allograft pericardium, allograft acellular dermis, amniotic membrane,Wharton's jelly, and combinations thereof.

Additional sources of mammalian basement membrane include, withoutlimitation, spleen, lymph nodes, salivary glands, prostate, pancreas andother secreting glands.

The ECM material can also be derived from other sources, including,without limitation, collagen from plant sources and synthesizedextracellular matrices, i.e. cell cultures.

As is well known in the art, the noted ECM materials (and, hence,expandable ECM members formed therefrom) are capable of inducingbioremodeling and, hence, regeneration of cardiovascular tissue.

According to the invention, the ECM material can be formed into aparticulate, as described in U.S. Pat. Nos. 5,275,826, 6,579,538 and6,933,326, and Co-Pending application Ser. No. 13/573,569; which areincorporated by reference herein in their entirety, to form asponge-like expandable ECM member of the invention.

In some embodiments of the invention, the ECM material comprises anacellular, sterilized ECM material. According to the invention, the ECMmaterial can be sterilized and decellularized by various conventionalmeans. In a preferred embodiment of the invention, the ECM material issterilized and decellularized via a sterilization and decellularizationprocess disclosed in Co-Pending U.S. PCT Application No.PCT/US12/039,413 and Co-Pending U.S. application Ser. No. 13/480,140;which are incorporated by reference herein in their entirety.

In some embodiments of the invention, the ECM material (and/or anexpandable ECM member formed therefrom) comprises at least onesupplemental biologically active agents (or compositions), i.e. an agentor composition that induces or modulates a physiological or biologicalprocess, or cellular activity, e.g., hemostatic activity, cellproliferation, and/or growth and/or regeneration of tissue.

In some embodiments of the invention, the biologically active agentcomprises a hemostatic agent or composition.

In some embodiments, the hemostatic agent comprises thrombin.

In some embodiments, the hemostatic agent comprises fibrinogen.

In some embodiments, the hemostatic agent is selected from the groupcomprising fibronectin, plasminogen, aprotinin, α-2-antiplasmin, α-2macroglobulin, α-1-antitrypsin, epsilon-aminocaproic acid, tranexamicacid, and a plasmin activator inhibitor, e.g., PAI-1 and PAI-2.

In some embodiments of the invention, the biologically active agentcomprises a statin, i.e. a HMG-CoA reductase inhibitor. According to theinvention, suitable statins include, without limitation, atorvastatin(Lipitor®), cerivastatin, fluvastatin (Lescol®), lovastatin (Mevacor®,Altocor®, Altoprev®), mevastatin, pitavastatin (Livalo®, Pitava®),pravastatin (Pravachol®, Selektine®, Lipostat®), rosuvastatin(Crestor®), and simvastatin (Zocor®, Lipex®). Several actives comprisinga combination of a statin and another agent, such asezetimbe/simvastatin (Vytorin®), are also suitable.

In some embodiments of the invention, the biologically active agentcomprises a cell selected from the group comprising human embryonic stemcells, fetal cardiomyocytes, myofibroblasts, mesenchymal stem cells,autotransplated expanded cardiomyocytes, adipocytes, totipotent cells,pluripotent cells, blood stem cells, myoblasts, adult stem cells, bonemarrow cells, mesenchymal cells, embryonic stem cells, parenchymalcells, epithelial cells, endothelial cells, mesothelial cells,fibroblasts, osteoblasts, chondrocytes, exogenous cells, endogenouscells, stem cells, hematopoietic stem cells, bone-marrow derivedprogenitor cells, myocardial cells, skeletal cells, fetal cells,undifferentiated cells, multi-potent progenitor cells, unipotentprogenitor cells, monocytes, cardiac myoblasts, skeletal myoblasts,macrophages, capillary endothelial cells, xenogenic cells, allogeniccells, and post-natal stem cells.

In some embodiments of the invention, the biologically active agentcomprises a growth factor selected from the group comprising a plateletderived growth factor (PDGF), epidermal growth factor (EGF),transforming growth factor-α (TGF-α), transforming growth factor beta(TGF-β), fibroblast growth factor-2 (FGF-2), basic fibroblast growthfactor (bFGF), vascular epithelial growth factor (VEGF), hepatocytegrowth factor (HGF), insulin-like growth factor (IGF), nerve growthfactor (NGF), platelet derived growth factor (PDGF), tumor necrosisfactor α (TNA-α), and placental growth factor (PLGF).

In some embodiments of the invention, the biologically active agentcomprises includes chitin or a derivative thereof, e.g. chitosan. As setforth in detail in Co-Pending application Ser. No. 13/573,569, chitosanexhibits numerous beneficial properties that provide several beneficialbiochemical actions or activities, including anticoagulant activity.See, e.g., Aranaz, et al., Functional Characterization of Chitin andChitosan, Current Chemical Biology, vol. 3, pp. 203-230 (2009).

In some embodiments, the biologically active agent comprises apharmacological agent (or composition), i.e. an agent or compositionthat is capable of producing a desired biological effect in vivo, e.g.,stimulation or suppression of apoptosis, stimulation or suppression ofan immune response, etc.

According to the invention, the pharmacological agent or composition cancomprise, without limitation, antibiotics or antifungal agents,anti-viral agents, anti-pain agents, anesthetics, analgesics, steroidalanti-inflammatories, non-steroidal anti-inflammatories,anti-neoplastics, anti-spasmodics, modulators of cell-extracellularmatrix interactions, proteins, hormones, enzymes and enzyme inhibitors,anticoagulants and/or antithrombic agents, DNA, RNA, modified DNA andRNA, NSAIDs, inhibitors of DNA, RNA or protein synthesis, polypeptides,oligonucleotides, polynucleotides, nucleoproteins, compounds modulatingcell migration, compounds modulating proliferation and growth of tissue,and vasodilating agents.

In some embodiments of the invention, the perivalvular leak sealingapparatus comprises a expandable member comprising a biodegradablepolymeric material that is similarly capable of transitioning from apre-deployment configuration, wherein the expandable member is capableof being positioned at an interior valve region of a valve when thevalve is disposed in a cardiovascular structure, to a post-deploymentconfiguration, wherein, when the expandable member is disposed at theinternal valve region, the valve outer surface proximate the interiorvalve region is placed in intimate contact with host cardiovasculartissue of the cardiovascular structure at a cardiovascular structuretarget region and seals perivalvular leaks present at the structuretarget region.

According to the invention, suitable biodegradable polymeric materialscomprise, without limitation, polyhydroxyalkonates (PHAs), polylactides(PLLA) and polyglycolides (PLGA) and their copolymers, for examplepoly(ε-caprolactone-co-glycolide), polyanhydrides, and like polymers.

As also indicated above, in some embodiments of the invention, theexpandable member includes or comprises a support (or anchoring) memberthat is similarly capable of transitioning from a pre-deploymentconfiguration, wherein the support member and/or expandable member iscapable of being positioned at an internal valve region of a valve whenthe valve is disposed in a cardiovascular structure, to apost-deployment configuration, wherein, when the support member and/orexpandable member is disposed at the internal valve region, the valveouter surface proximate the interior valve region is placed in intimatecontact with host cardiovascular tissue of the cardiovascular structureat a cardiovascular structure target region and seals perivalvular leakspresent at the structure target region. Suitable support members aredisclosed in Co-Pending U.S. application Ser. Nos. 13/573,226,13/782,024 and 13/804,683, which are incorporated by reference herein.

In some embodiments of the invention, the support member comprises areinforcing ring or band that is positioned on or in the expandablemember.

In a preferred embodiment of the invention, the support member comprisesa biocompatible material.

Thus, in some embodiments, the support member comprises Nitinol®.

In some embodiments, the support member comprises stainless steel.

In some embodiments, the support member comprises a cobalt-chrome nickelalloy.

In some embodiments of the invention, the support member comprises abiocompatible and biodegradable material.

In some embodiments, the support member thus comprises magnesium or analloy thereof.

In some embodiments of the invention, the metal support members includea coating of an immunomodulating compound that suppresses acute immuneresponses, while up regulating chronic immune response (i.e. tissuereconstruction).

In some embodiments, the immunomodulating compound comprises apolysaccharide, including, without limitation, GAGs, dextrans, alginateand chitosan.

In some embodiments, immunomodulating compound comprises a polymericmaterial, including, without limitation, high molecular weighthyaluronic acid (HMW-HA).

In some embodiments, the support member comprises a biocompatiblepolymeric material selected from the group comprising, withoutlimitation, polyhydroxyalkonates (PHAs), polylactides (PLLA) andpolyglycolides (PLGA) and their copolymers, for examplepoly(ε-caprolactone-co-glycolide), polyanhydrides, and like polymers.

In some embodiments, the support member comprises Artelon™.

In some embodiments, the support member comprises a cross-linked ECMmaterial.

In some embodiments, the support member comprises a microneedle supportmember, such as disclosed in Co-Pending U.S. application Ser. No.13/686,131, having a plurality of biodegradable microneedles or barbsthat are configured and positioned to maintain the desired position ofthe valve outer surface or region proximate host tissue at a targetcardiovascular structure region and any perivalvular leaks present atthe cardiovascular structure target region.

In some embodiments, the microneedles comprise drug-eluting members thatfacilitate the direct administration of a biologically active agent tohost tissue, e.g. cardiovascular tissue.

According to the invention, the perivalvular leak sealing apparatus ofthe invention can be delivered to an internal region of a replacement orprosthetic valve via various conventional means. In a preferredembodiment, the perivalvular leak sealing apparatus of the invention aredelivered to an internal region of a prosthetic valve via percutaneousdelivery, i.e. feeding a guide wire through a cardiovascular vessel.

Referring now to FIGS. 2-5, a first embodiment of a perivalvular leaksealing apparatus of the invention (denoted “20”) will be described indetail.

Referring first to FIG. 1, as stated above, typically, a replacementvalve 14 a, such as the prosthetic valves disclosed in Co-Pending U.S.application Ser. Nos. 13/782,024 and 13/804,683, is disposed over nativevalve leaflets 12, which are often calcified. The calcified leaflets 12are thus wedged between the replacement valve 14 a and the vessel 16,resulting in gaps 18 between the valve 14 a and vessel 16, which can,and often will, lead to one or more perivalvular leaks.

According to the invention, the perivalvular leak sealing apparatusillustrated in FIGS. 2-3 and 6-7, as well as other embodiments thereof,can be readily positioned in a valve proximate the gaps 18 to seal anyperivalvular leaks present at the gaps 18.

As indicated above, in some embodiments of the invention, the sealingapparatus 20 comprises a biocompatible, expandable member 22 that iscapable of transitioning from a pre-deployment configuration (as shownin FIG. 2), wherein the expandable member 22 is capable of beingpositioned at an interior valve region 15 a of the valve 14 a (and valve14 b) when the valve 14 a (and valve 14 b) is disposed in acardiovascular vessel 16 (as shown in FIG. 4) or structure 17 (as shownin FIG. 5), to a post-deployment configuration (as shown in FIG. 3),wherein, when the expandable member 22 is disposed at the interior valveregion 15 a, the valve outer surface or region 15 b proximate theinterior valve region 15 a is placed in intimate contact with hostcardiovascular tissue 21 of the cardiovascular vessel 16 or structure 17at a cardiovascular structure target region (denoted “CS_(TR)”) andseals perivalvular leaks present at the structure target region“CS_(TR)”.

As indicated above, the expandable member can comprise variousbiocompatible materials, including any of the aforementionedbiodegradable polymeric materials.

According to the invention, the expandable member 22 can also comprisevarious pre-deployment configurations or shapes, e.g. oblong, circular,etc. In a preferred embodiment, the expandable member 22 has asubstantially circular post-deployment configuration.

In some embodiments of the invention, the expandable member 22 comprisesa bioremodelable material, more preferably, an extracellular matrix(ECM) material (hereinafter “expandable ECM member”) derived from amammalian tissue source, including, without limitation, small intestinesubmucosa (SIS), urinary bladder submucosa (UBS), stomach submucosa(SS), central nervous system tissue, epithelium of mesodermal origin,i.e. mesothelial tissue, dermal extracellular matrix, subcutaneousextracellular matrix, gastrointestinal extracellular matrix, i.e. largeand small intestines, tissue surrounding growing bone, placentalextracellular matrix, ornamentum extracellular matrix, cardiacextracellular matrix, e.g., pericardium and/or myocardium, kidneyextracellular matrix, pancreas extracellular matrix, lung extracellularmatrix, and combinations thereof.

In some embodiments of the invention, the expandable ECM member 22 has asponge-like structure, i.e. a flexible, porous structure that is capableof absorbing a bodily fluid and expanding when disposed thereto.

In some embodiments, the ECM material (and/or expandable ECM member 22formed therefrom) comprises at least one supplemental biologicallyactive agent (or composition).

In some embodiments of the invention, the biologically active agentcomprises a hemostatic agent or composition.

In some embodiments, the hemostatic agent comprises thrombin.

In some embodiments, the hemostatic agent comprises fibrinogen.

In some embodiments, the hemostatic agent is selected from the groupcomprising fibronectin, plasminogen, aprotinin, α-2-antiplasmin, α-2macroglobulin, α-1-antitrypsin, epsilon-aminocaproic acid, tranexamicacid, and a plasmin activator inhibitor, e.g., PAI-1 and PAI-2.

In some embodiments of the invention, the biologically active agentcomprises a statin, i.e. a HMG-CoA reductase inhibitor, selected fromthe group comprising atorvastatin, cerivastatin, fluvastatin,lovastatin, mevastatin, pitavastatin, pravastatin, rosuvastatin, andsimvastatin.

In some embodiments of the invention, the biologically active agentcomprises chitosan.

In some embodiments of the invention, the biologically active agentcomprises one or more of the aforementioned cells, including, withoutlimitation, human embryonic stem cells, mesenchymal stem cells,parenchymal cells, epithelial cells and endothelial cells.

In some embodiments of the invention, the biologically active agentcomprises one or more of the aforementioned growth factors, including,without limitation, a platelet derived growth factor (PDGF),transforming growth factor-α (TGF-α), transforming growth factor beta(TGF-β), fibroblast growth factor-2 (FGF-2), basic fibroblast growthfactor (bFGF) and vascular epithelial growth factor (VEGF).

In some embodiments of the invention, the biologically active agentcomprises one or more of the aforementioned pharmacological agents orcompositions, including, without limitation, an antibiotic, anti-viralagent, and anti-inflammatory.

As indicated above, in some embodiments of the invention, theperivalvular leak sealing apparatus 22 comprises a biocompatible shapememory alloy member that is configured to engage the interior valveregion 15 a of a valve (for purposes of illustration only “valve 14 a”),the expandable member 22 similarly being capable of transitioning from apre-deployment configuration at a first temperature, wherein theexpandable member 22 is capable of being positioned within the valve 14a at an interior valve region 15 a when the valve 14 a is disposed isdisposed in a cardiovascular vessel 16 or structure, the cardiovascularvessel 16 and structure comprising host cardiovascular tissue 21 havinga first tissue temperature, to a post-deployment configuration when theexpandable member 22 is disposed proximate the cardiovascular tissue 21and subjected to the first tissue temperature, wherein, when theexpandable member 22 is disposed in the internal valve region 15 a, thevalve outer surface or region 15 b proximate the interior valve region15 a is placed in intimate contact with the host cardiovascular tissue21 of the cardiovascular vessel 16 or structure at a cardiovascularstructure target region “SC_(TR)” and seals perivalvular leaks presentat the structure target region SC_(TR).

Referring now to FIGS. 6-7, there are shown further embodiments of theexpandable member 22, wherein the expandable member 22 includes asupport (or anchoring) member 26. As illustrated in FIGS. 6-7, in apreferred embodiment, the support member 26 comprises a reinforcing ringor band.

In some embodiments, the support member 26 is disposed in the expandablemember, as shown in FIG. 6. In some embodiments, the support member 26is disposed proximate the outer surface 23 of the expandable member 22,as shown in FIG. 7.

According to the invention, the support member is similarly capable oftransitioning from a pre-deployment configuration, wherein the supportmember 26 (and, hence, expandable member 22 associated therewith) iscapable of being positioned in the interior valve region 15 a of acardiovascular valve (for purposes of illustration only “valve 14 a”),to a post-deployment configuration, wherein, when the support member 26(and, hence, expandable member 22 associated therewith) are disposed inthe interior valve region 15 a, the valve outer surface or region 15 bproximate the interior valve region 15 a is placed in intimate contactwith the host cardiovascular tissue 21 of a cardiovascular vessel 16 orstructure at a cardiovascular structure target region “SC_(TR)” andseals perivalvular leaks present at the structure target region SC_(TR).

According to the invention, the support member 26 can comprise any ofthe aforementioned biocompatible metals, including, Nitinol®, magnesium,stainless steel, and cobalt-chrome nickel alloys.

The support member 26 can also comprise a polymeric material, such asArtelon™, or a cross-linked ECM material.

In some embodiments of the invention, the support member 26 comprisesNitinol®. As discussed in detail in U.S. Pat. No. 8,808,363, theNitinol® support members are capable of transitioning from apre-deployment configuration at a first temperature, to apost-deployment configuration at a second temperature, which, in someembodiments, comprises host tissue temperature.

Referring now to FIG. 8, in some embodiments, the support membercomprises a microneedle support member 28 having a plurality ofbiodegradable microneedles (or barbs) 30. In a preferred embodiment, themicroneedles 30 are configured and positioned to maintain the positionof the expandable member 22 proximate host tissue of a cardiovascularstructure.

In some embodiments, the microneedles 30 comprise drug-eluting membersthat facilitate the direct administration of a biologically active agentto host tissue, e.g. cardiovascular tissue 21.

According to the invention, when the perivalvular leak sealing apparatus20 comprises one of the aforementioned ECM materials and includes thesupport member 26 shown in FIGS. 6-7 and/or the microneedle supportmember 28, shown in FIG. 8, and is positioned in the interior valveregion 15 a of a cardiovascular valve 14 a or 14 b and transitions to(or is in) a post-deployment configuration, the valve outer surface orregion 15 b proximate the interior valve region 15 a is placed inintimate contact with the host cardiovascular tissue 21 of acardiovascular vessel 16 or structure 17 at a cardiovascular structuretarget region “SC_(TR)” and abates, i.e. substantially reduces oreliminates, perivalvular leaks present at the structure target regionSC_(TR). Thereafter, cardiovascular tissue is regenerated via thebioremodelable ECM material to further seal the perivalvular leak(s),i.e. a two-stage sealing process.

As will readily be appreciated by one having ordinary skill in the art,the present invention provides numerous advantages. Among the advantagesare the following:

-   -   The provision of a perivalvular leak sealing apparatus that can        be readily employed to effectively seal perivalvular leaks.    -   The provision of a two-stage perivalvular leak sealing apparatus        that can be readily employed to effectively seal perivalvular        leaks.    -   The provision of perivalvular leak sealing apparatus that induce        cell proliferation, bioremodeling and regeneration of new        cardiovascular tissue and tissue structures with site-specific        structural and functional properties.    -   The provision of perivalvular leak sealing apparatus that can        administer a biologically active agent to cardiovascular tissue        and, thereby, produce a desired biological and/or therapeutic        effect.

Without departing from the spirit and scope of this invention, one ofordinary skill can make various changes and modifications to theinvention to adapt it to various usages and conditions. As such, thesechanges and modifications are properly, equitably, and intended to be,within the full range of equivalence of the following claims.

What is claimed is:
 1. A perivalvular leak sealing apparatus,comprising: a biocompatible, expandable member that is configured toengage an interior region of a prosthetic cardiovascular valve, saidvalve having an outer surface, said expandable member comprising abiocompatible shape memory alloy, said expandable member being capableof transitioning from a pre-deployment configuration at a firsttemperature, wherein said expandable member is capable of beingpositioned in said valve at a first interior valve region when saidvalve is disposed in a cardiovascular structure, said cardiovascularstructure comprising host cardiovascular tissue having a first tissuetemperature, to a post-deployment configuration when said expandablemember is disposed proximate said cardiovascular tissue and subjected tosaid first tissue temperature, wherein, when said expandable member isdisposed in said first interior valve region of said valve, a firstouter surface region proximate said first interior valve region isdisposed in intimate contact with said host cardiovascular tissue ofsaid cardiovascular structure at a first cardiovascular structure targetposition, and wherein a perivalvular leak present at said firstcardiovascular structure target position is sealed.
 2. The sealingapparatus of claim 1, wherein said biocompatible shape memory alloycomprises Nitinol®.
 3. A perivalvular leak sealing apparatus,comprising: a biocompatible, expandable member that is configured toengage an interior region of a prosthetic cardiovascular valve, saidvalve having an outer surface, said expandable member comprising abioremodelable extracellular matrix (ECM) material from a mammaliantissue source, said expandable member being capable of transitioningfrom a pre-deployment configuration, wherein said expandable member iscapable of being positioned within said valve at a first interior valveregion when said valve is disposed in a cardiovascular structure, to apost-deployment configuration, wherein, when said expandable member isdisposed in said first interior valve region of said valve, a firstouter surface region of said valve proximate said first interior valveregion is disposed in intimate contact with host cardiovascular tissueof said cardiovascular structure at a first cardiovascular structuretarget position and abates at least one perivalvular leak present atsaid first cardiovascular structure target position during a firstsealing stage, and wherein, after a first period of time after saidfirst valve region is placed in said intimate contact with said hostcardiovascular tissue of said cardiovascular structure at said firstcardiovascular structure target position, said expandable memberremodels and further abates said perivalvular leak.
 4. The sealingapparatus of claim 3, wherein said mammalian tissue source comprises atissue source selected from the group consisting of the small intestinesubmucosa, urinary bladder submucosa, stomach submucosa and mesothelialtissue.
 5. The sealing apparatus of claim 3, wherein said expandablemember comprises a flexible, porous structure.
 6. The sealing apparatusof claim 3, wherein said ECM material comprises an exogenously addedsupplemental biologically active agent.
 7. The sealing apparatus ofclaim 6, wherein said biologically active agent comprises a hemostaticagent.
 8. The sealing apparatus of claim 7, wherein said hemostaticagent comprises thrombin.
 9. The sealing apparatus of claim 7, whereinsaid hemostatic agent comprises fibrinogen.
 10. The sealing apparatus ofclaim 7, wherein said hemostatic agent is selected from the groupcomprising fibronectin, plasminogen, aprotinin, α-2-antiplasmin, α-2macroglobulin, α-1-antitrypsin, epsilon-aminocaproic acid, andtranexamic acid.
 11. The sealing apparatus of claim 6, wherein saidbiologically active agent comprises chitosan.
 12. The sealing apparatusof claim 6, wherein said biologically active agent comprises a HMG-CoAreductase inhibitor selected from the group consisting of atorvastatin,cerivastatin, fluvastatin, lovastatin, mevastatin, pitavastatin,pravastatin, rosuvastatin, and simvastatin
 13. The sealing apparatus ofclaim 6, wherein said biologically active agent comprises a growthfactor selected from the group consisting of a platelet derived growthfactor (PDGF), transforming growth factor-α (TGF-α), transforming growthfactor beta (TGF-β), fibroblast growth factor-2 (FGF-2), basicfibroblast growth factor (bFGF) and vascular epithelial growth factor(VEGF).
 14. The sealing apparatus of claim 3, wherein said expandablemember comprises a microneedle support member comprising a plurality ofbiodegradable microneedles.
 15. The sealing apparatus of claim 14,wherein said biodegradable microneedles comprise drug-eluting members.16. A perivalvular leak sealing apparatus, comprising: a biocompatible,expandable member that is configured to engage an interior region of aprosthetic cardiovascular valve, said expandable member comprising abiocompatible polymeric material selected from the group consisting ofpolyhydroxyalkonates (PHAs), polylactides (PLLA) and polyglycolides(PLGA) and their copolymers, for examplepoly(ε-caprolactone-co-glycolide) and polyanhydrides, said expandablemember being capable of transitioning from a pre-deploymentconfiguration, wherein said expandable member is capable of beingpositioned within said valve at a first interior valve region when saidvalve is disposed in a cardiovascular structure, to a post-deploymentconfiguration, wherein, when said expandable member is disposed in saidfirst interior valve region of said valve, a first outer surface regionof said valve proximate said first interior valve region is disposed inintimate contact with said host cardiovascular tissue of saidcardiovascular structure at a first cardiovascular structure targetposition, and wherein a perivalvular leak present at said firstcardiovascular structure target position is sealed.